HIPAA TRANSACTIONS 2002 UPDATE

1. HIPAATRANSACTIONS2002 UPDATE

2. Donna Eden • Office of the General Counsel • Department of Health and Human Services HHS Office of General Counsel

3. The information and views in this presentation do not represent official views of the U.S. Department of Health and Human Services HHS Office of General Counsel

4. Transactions • In implementation, finally • Process for modifications in place • Code sets • Sets missing • Codes missing • Local codes consolidation • HIPAA Web Site transition HHS Office of General Counsel

5. Transaction/Code Sets Timetable • Final Regulation published in August, 2000 • Original compliance date: October 16, 2002 • Many sectors of health care requested additional time to build, test, and successfully implement the standards HHS Office of General Counsel

6. Congress’ Response • Administrative Simplification Compliance Act (ASCA) • Signed into law by President Bush on December 27, 2001 as Public Law 107-105 • Allows covered entities to request a one-year extension for transactions compliance • Does not affect other HIPAA standards HHS Office of General Counsel

7. ASCA Provisions • Directed to covered entities with October 16, 2003 compliance date for full implementation of Transactions Rule • IF compliance extension plan submitted to HHS by 10/15/2002 • THEN compliance date is extended to 10/16/2003 HHS Office of General Counsel

8. Model Form • HHS to publish a model compliance extension form by March 31, 2002 • Model form or another format • File electronically or via paper • No funds appropriated, but $44.2 million authorized -- decreases if HHS misses March 31 deadline

9. Small Health Plans • Small health plans currently have a compliance date of October 16, 2003 • No further extension for small plans • What is “small”? • Providers with fewer than 25 FTEs • Practitioners et al. with fewer than 10 FTEs HHS Office of General Counsel

10. Compliance Extension Form:Required Elements • Reasons for non-compliance • Schedule for transaction implementation • Work plan and budget • Implementation strategy • Planned use of contractors or vendors • Time frame for testing, starting no later than April 16, 2003 HHS Office of General Counsel

11. Compliance Plan FormInstructions • Summary information only • No space for information protected as • Trade secrets or proprietary information • Personal information • Agents may submit form on behalf of covered entities HHS Office of General Counsel

12. Congressional Purposes • Completion of extension plans • requires covered entities to develop a plan for compliance • provides useful data to NCVHS • Not to add new burdens on covered entities HHS Office of General Counsel

13. Extension Based on Submission of Form • No separate review • Proof of extension from receipt • electronic, automatic if submitted electronically • U.S. Mail or other service HHS Office of General Counsel

14. National Committee on Vital and Health Statistics • Sample of compliance extension plans to be provided to NCVHS • NCVHS will • identify common barriers to compliance activities • publish recommendations for solving the problems HHS Office of General Counsel

15. Developing the Model Form • Workgroup for Electronic Data Interchange (WEDI) convened industry group to draft a model compliance extension form, which they have recommended to the Secretary. • Providers, plans, and vendor organizations all included in group HHS Office of General Counsel

16. NCVHS Hearing • Hearing on February 7, 2002 • Reviewed form, heard comments • General consensus: KISS principle • Subcommittee in general agreement with form HHS Office of General Counsel

17. NHVHS Concerns • Promote use of model form via web • Address provider concerns about disclosure of proprietary information HHS Office of General Counsel

18. ASCA: Medicare Exclusions • Secretary may exclude providers from participating in Medicare after October 16, 2002 if : • no compliance extension form submitted • not compliant by October 16, 2002 • HHS will initiate rulemaking HHS Office of General Counsel

19. ASCA: Medicare Claims • After October 16, 2003 Medicare may no longer pay paper claims • Exceptions: • No method for electronic submission • Small providers of services or supplies • Provider with less than 25 FTEs • Practitioner, et al., less than 10 FTEs • Unusual circumstances HHS Office of General Counsel

20. Future Actions • First Transactions modifications • Corrections • Changes based on SDO reviews and DSMO process HHS Office of General Counsel

21. Final HIPAA RegulationsTo Come • National Provider Identifier • Employer Identifier • Security • Electronic Signature HHS Office of General Counsel

22. Proposed HIPAA Rules To Come • Privacy modifications • National Plan Identifier • Claims Attachments • Annual modifications HHS Office of General Counsel

23. Covered Entity To Do List • Monitor CMS web site for form • Submit form if extension desired • Work with IT staff and vendors • Contact your trading partners • Join WEDI/SNIP efforts • Support SDOs • Use the delay time to reach compliance HHS Office of General Counsel

24. Web Sites • Transactions and code sets • www.cms.gov • Washington Publishing Co. • http://www.wpc-edi.com • National Committee on Vital and Health Statistics: • http://aspe.hhs.gov/ncvhs/ HHS Office of General Counsel

25. More Resources • Workgroup on Electronic Data Interchange: • http://wedi.org • WEDI/Strategic National Implementation Process: • http://snip.wedi.org • Privacy: • http://www.hhs.gov/ocr/hipaa/ HHS Office of General Counsel